Journal Menu

Member In
plagscan
road-issn
ICI World of Journals
publons
Academic Resource Index
Academic Resource Index
google scholar

Recommended Journals

Research Article
Volume 1 Issue 3 - 2017
Epidemiological and Lesional Aspects of Traumatic Floating Knees
Dossou FM, Padonou A*, Amossou F, Lawson E, Chigblo P and Yassaho U
Service de Chirurgie Générale-CHUD Ouémé-Plateau, Porto-Novo-BENIN
*Corresponding Author: Dr Padonou Adébola, Service de Chirurgie Générale-CHUD Ouémé-Plateau, Porto-Novo-BENIN.
Received: December 29, 2016; Published: January 04, 2017
Abstract
The floating knee is a particular lesional entity described for the first time in 1974 by Blake and McBryde and which associates a fracture of the femur with a homolateral fracture of the tibia. This lesion was isolated, among other things, because of its severity. We report in this work the study of a series of 22 cases of floating knee in their epidemiological and lesional aspects. It was a joint retrospective and prospective study covering a period of three and a half years, from 01 January 2013 to 30 June 2016, dealt with at general surgery division of the Department University Hospital of the Ouémé Plateau.
The average age in our series was 38.91 years with extremes of 10 and 67 years, the sex ratio was 4.5 in favor of the male sex. All socio-occupational categories were represented with the majority of workers at 31.80%. Highway accidents accounted for 86.40% of the main etiology. Most patients in our series were 68.20% on the left side. The fractures were open in the femur and in the tibia in 22.60% and 72.70%, respectively. We recorded all types of floating knees according to the FRASER classification, with a clear predominance of type I at 81.80%. There has been a steady increase in the recrudescence of floating knees over the years.
The floating knee, in our context, is a rare but serious lesion of young adults, favored by the development and the celerity of the means of transport.
Keywords: Floating knee; Ipsilateral fracture
Introduction
The floating knee is a lesional entity that associates a fractured femur with an ipsilateral fracture of the tibia. Described for the first time in 1974 by Blake and McBride [1], it isolates the knee joint from the rest of the pelvic limb. Severe and generally occurring in a context of violent trauma, the floating knee can be grafted with formidable associated lesions.
The aim of this work is to describe the epidemiological and lesional aspects of the floating knees in our practice.
Materials and Methods
This was a three-year retrospective descriptive study from January 1, 2013 to December 31, 2015, followed by a six-month prospective study from January 1, 2016 to June 30, 2016. We included all patients admitted to surgical emergencies for a traumatic floating knee with a complete medical record (complete clinical observation, x-rays of the femur and leg). Patients with incomplete medical records were excluded from this study.
The following variables were examined: epidemiology (frequency, age, sex, occupation), admission time, mode of admission (firefighters, four-wheeled vehicles, two-wheeled vehicles), etiology, type of collision in the event of a road accident, fractured side, anatomopathological type of lesions according to the Fraser classification (Figure 1) [2], distribution by opening or not, distribution of the open lesions according to the bone segment, type of opening according to the classification of Gustillo and Anderson.
Hospital records and patient records were used to collect data. The data were collected using a survey form.
Figure 1: The FRASER classification of floating knees [2].
Results
Frequency
During the study period, 22 floating knees were collected, i.e. approximately 6 cases per year. Floating knees accounted for 0.39% of hospitalizations in the study period.
Age and sex
The average age of patients was 38.91 years with extremes of 10 years and 67 years. Table I shows the distribution of patients by age group. The ages of 21 years to 40 years and those of 41 years to 60 years were the most affected in respectively 11 cases and 8 cases.
Age Bracket Number of cases
0 to 20 years 1
21 to 40 years 11
41 to 60 years 8
61 years and over 2
Table I: Distribution by Age Bracket.
18 men and 4 women were involved, making a sex ratio of 4.5. Table II shows the distribution by age and sex. It was found that men were the most affected in the age brackets of 21 to 40 years and 41 to 60 years in 9 cases and 6 cases respectively.
  Male Female
0 to 20 years 1 0
21 à 40 years 9 2
41 à 60 years 6 2
61 years and over 2 0
Table II: Distribution by age and sex.
Occupation
Table III shows the distribution of patients by profession. Workers were the most affected socio-occupational group in 9 cases.
Occupation Total Number
Civil servants 3
Workers 9
Farmers 3
Tradepeople 5
Others 2
*Other: 1 motorcycle taxi driver and 1 student.
Table III: Distribution by occupation.
Time and method of admission
All patients were admitted within the first hour following the trauma and without taking by another health center.
Table IV shows the distribution of patients by mode of transportation to the hospital. 10 patients were transported by firefighters.
Means of Transport Number of cases
Firefighters 10
Four-wheeled vehicles 5
Two-wheeled vehicles 7
Table IV: Distribution by Means of Transport to Hospital.
Etiology and type of collision
Road accident was the most common etiology with 19 cases (86.40%). For the other etiologies, there were two cases of landslide and one case of brawls.
As concerns road accident cases, motorcycle-with-motorcycle collisions accounted for 10 cases, motorcycle-with-automotive collision for 8 cases, and a motorcycle-with-pedestrian collision in 1 case.
Affected side
We recorded a more frequent attack on the left side with 15 cases as against 7 cases for right-side lesions.
Anatomopathomopathological distribution
Table V shows the distribution of lesions according to the Fraser classification. Type I was the most frequent, with 18 cases.
Type Number
Type I 18
Type Iia 2
Type IIb 2
Type IIc 0
Table V: Lesion distribution according to FRASER classification.
Breakdown by opening or not
Of the 22 floating knees, 17 cases were considered open either on one of the 2 segments, or on 2 at the same time.
Distribution of open lesions according to the bone segment
Of the 17 open lesions, the single break cases involved the leg segment in 12 cases, and the thigh in 1 case. The simultaneous involvement of thigh and leg amounts to 4 cases.
Distribution of the type of opening according to Gustillo and Anderson
Table VI shows the distribution of the type of opening according to the bone segment, and according to the classification of Gustillo and Anderson. Types IIIa and IIIb were the most found in the tibia in respectively 10 cases and 2 cases, as against 3 cases and 1 in the femur. Type IIIc was found in only one case in the tibia.
Open fractures Femur Tibia

Type I

 0 0

Type II

 1 3

Type IIIa

 3 10

Type IIIb

 1 2

Type IIIc

 0 1
Table VI: Distribution of the open lesions according to the bone segment and according to the classification of Gustillo and Anderson.
Discussion
The floating knee is an uncommon lesional entity in our daily practice. We collected 22 cases in three and a half years, an average of about 6 cases per year. This result is superimposable to those of other studies in our African context. Thus, Hans-Moevi., et al. [3] in Benin and Agoh., et al. in Cote d'Ivoire [4] reported 53 cases in 10 years and 55 cases in 10 years, respectively. On the other hand, this is significantly higher than the 39 cases in 18 years reported by Zrig., et al. [5], in Morocco. In France, Pietu., et al. [6], reported 172 cases in a multicentre study.
In Asia, Rethnam., et al. [7] in India and Yokoyama., et al. [8] in Japan, reported 29 cases in 3 years and 67 cases in 14 years, respectively. The largest series remains Fraser [2] with 222 cases in 10 years in Canada.
The average age of our patients was 38.91 years. It is close to that found by Abalo., et al. [9] in Lomé (37 years) but superior to those of Mezouri., et al. [10] (22u) and Hikmat., et al. [11] (23u) in Morocco with an average age of 35 years and 30.6 years respectively.
Young adults in full economic activity, therefore more active and more mobile, are the most affected. The 21 to 40 age group was the most represented with half of the total workforce. In most studies, sex ratio is largely in favor of men [12-13], probably because they are the most numerous users of the road network but certainly also the most reckless.
Workers were the most important professional layer both in our study and in that of Gogoua., et al. [14], in Côte d'Ivoire.
All our patients were admitted within the first hour after the trauma without taking through another health center. The severity of the lesions as well as the unavailability of a technical platform able to manage this type of patient in most peripheral centers account for this rather unusual attitude of the populations who generally prefer to consult first at the secondary centers.
Road accidents were, in our context, the main cause of floating knee. The finding is the same for Hans-Moevi., et al. [3] in Cotonou and Abalo., et al. [9] in Lomé, with mainly motorcycle-vehicle collision in 72.57% in Cotonou and 100% in Lomé whereas we found ourselves rather a majority proportion of motorcycle-with-motorcycle collisions. This could be explained by the fact that the motorcycle is by far the most common means of transport in Beninese cities.
As for lesions, we recorded 18 cases of Fraser type I floating knees. This result is consistent with those of the different African series [4,5,9, 11-14].
There were 17 cases of open lesions, with an isolated lesion of the tibial segment in 12 cases. The subcutaneous situation of the tibia associated with the most frequent type of collision (motorcycle-with-motorcycle in 10 cases), in our context, could account for this result.
Open fractures of type IIIa were the most frequent in our series with a clear predominance on the tibia in 10 cases. This reflects the violence of the trauma involved causing extensive lesions of soft tissues.
Conclusion
Floating knees are a relatively rare infectious entity in our daily practice. However, it affects a young population, with a clear male predominance. The etiology is dominated by road accidents with a motorcycle-with-motorcycle collision providing diaphyseal involvement of the two bone segments. Open lesions are the most frequent with a clear predominance of opening of type IIIA to the leg segment showing extensive lesions of the soft parts.
A prospective study on the management of these lesions, taking into account the means of bone restraint and the management of the extensive lesions of the soft parts, will make it possible to evaluate the anatomical and functional prognosis of these lesions.
Acknowledgements
A short acknowledgement section can be written acknowledging the sources regarding sponsorship and financial support. Acknowledging the contributions of other colleagues who are not included in the authorship of this paper should also be added in this section. If there are no acknowledgements, then this section need not be mentioned in the paper.
Conflict of interest
Any financial interest or any conflict of interest.
References
  1. Blake R and McBride A. “The Floating Knee: Ipsilateral Fractures of the Tibia and Femur”. Southern Medical Association 68.1 (1975): 13-6.
  2. Fraser RD., et al. “Ipsilateral Fracture of the Femur and Tibia”. The Journal of Bone & Joint Surgery 60-B.4 (1978): 510-250.
  3. Hans-Moevi Akué A., et al. “Les genoux flottants traumatiques. Aspects épidémiologiques, thérapeutiques et évaluation des résultats”. Tunisie Orthopédique 6.1 (2013): 81-4.
  4. Agoh S., et al. “Le genou flottant: à propos de 55 cas traités au CHU de Cocody à Abidjan”. Tunisie Orthopédique 3.2 (2010):160-164.
  5. Zrig M., et al. “Le genou flottant : étude rétrospective de 39 cas”. Tunisie Orthopédique 1.2 (2008): 165-70.
  6. Piétu G., et al. “les membres du GETRAUM. Le genou flottant : étude rétrospective de 172 cas”. Rev Chir Orthop 93 (2007): 627-634.
  7. Rethnam U., et al. “The Floating Knee: epidemiology, Prognostic Indicators & Outcome Following Surgical Management”. Journal of Trauma Management & Outcomes 1.2 (2007): 1-8.
  8. Yokoyama K., et al. “Evaluation of Functional Outcome of the Floating Knee Injury Using Multivariate Analysis”. Archives of Orthopaedic and Trauma Surgery 122.8 (2002): 432-435.
  9. Abalo A., et al. “Floating Knee: Epidemiology and Results of Treatment”. Nigerian Journal of Orthopaedics and trauma 10.1 (2011):
  10. Mezouri I. Fractures ipsilatérales du fémur et du tibia ou genou flottant (A propos de 23 cas). Thèse de doctorat en médecine n°021/10. Année 2010. Faculté de médecine de FES. Université SIDI MOHAMMED BEN ABDELLAH.
  11. Hikmat W. Le genou flottant à propos de 30 cas. Thèse de doctorat en médecine n°026/11. Année 2011. Faculté de médecine et de pharmacie de MARRAKECH. Université CADI AYYAD.
  12. Elmrini A., et al. “Ipsilateral Fractures of Tibia and Femur or Floating Knee”. International Orthopaedics (SICOT) 30.5 (2006): 325-328.
  13. Hegazy AM. “Surgical Management of Ipsilateral Fracture of the Femur and Tibia in Adults (the floating knee): Postoperative Clinical, Radiological, and Functional Outcomes”. Clinics in Orthopedic Surgery 3.2 (2011): 133-139.
  14. Gogoua M., et al. "Genou flottant traumatique, aspect épidémiologique et évolutif à propos de 35 cas". Médecine d'Afrique noire 49 (2002): 404-408.
Citation: Padonou Adébola., et al. “Epidemiological and Lesional Aspects of Traumatic Floating Knees”. Orthopaedic Surgery and Traumatology 1.3 (2017): 94-99.
Copyright: © 2017 Padonou Adébola., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.